Provider Demographics
NPI:1497807358
Name:MOORE HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:MOORE HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUDEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGELETY-MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:219-392-6858
Mailing Address - Street 1:9000 INDIANAPOLIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2501
Mailing Address - Country:US
Mailing Address - Phone:219-923-2655
Mailing Address - Fax:219-923-2640
Practice Address - Street 1:9000 INDIANAPOLIS BLVD STE A
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2501
Practice Address - Country:US
Practice Address - Phone:219-923-2655
Practice Address - Fax:219-923-2640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06-009757-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200131190AMedicaid
IN200112780AOtherWAIVER
IN200131190AMedicaid